Transcript The role of diet and nutrition in the management of People

The role of diet and nutrition in
the management of People
living with HIV/AIDS
Sessions Objectives
• To understand the importance of Nutrition
in management of PLHA
• To understand the counseling strategies
needed to food and nutrition habits
Exercise 1
• Brainstorm on the importance of diet and
nutrition in the life of people living with
HIV/AIDS
HIV/AIDS AND NUTRITION
Eating correctly does make a
difference!
When your body gets enough of the right food, you
will feel better and more positive about yourself
and the future.
Eating the right food can help your immune system
to fight infection. It can also help your body to stay
stronger during any medical treatment that you
may need.
Many of the physical symptoms of HIV/AIDS can be
made better or worse by the foods you eat.
Objectives of nutrition Counseling
• Maintaining body weight and strength;
• Replacing lost vitamins and minerals;
• Improving the function of the immune system and the body's
ability to fight infection;
• Extending the period from infection to the development of
the AIDS disease;
• Improving response to treatment; reducing time and money
spent on health care;
• Keeping HIV-infected people active, allowing them to take
care of themselves, their family and children; and
• Keeping HIV-infected people productive, able to work, grow
food and contribute to the income of their families.
What is good nutrition?
Good nutrition means eating foods
each day that will give you the
nutrients (vitamins, minerals and
proteins) that your body needs to
keep it strong and healthy.
Energy
• 40 kcal/kg body weight to maintain weight
(300 – 400 kcals above RDA for male & female)
• 55 kcal/kg to increase wt or stop wt loss
• Allows possibility of current or future
hypermetabolism
• Safety margin for decreased food intake
during acute disease
Protein
• Body building
• To improve immunity
• 0.8 – 1.0 g/kg body wt for normal person
• 1.2 – 2.0 g/kg for HIV-infected person
Fat
• Essential fatty acids (n-3)
– Alpha Linolenic acid
– Eicosapentanoic acid (EPA)
– Docosahexanoic acid (DHA)
Rich source – Fish oils
• Low fat diet - Avoid fried & oily foods
• Avoid saturated fat
Vitamin A
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Accelerated HIV disease progression
Increased adult mortality
Increased mother to child transmission of HIV
Higher infant mortality & growth failure
Higher HIV load in breast milk
Presence of HIV-1 DNA in vagina contributes
to heterosexual transmission of HIV
Vitamin A: 5000 – 10000 IU/day
β-carotene: 50000 – 100000 IU/day
Vitamin D
• Low serum level of 1,25dihydroxyvitamin D3, was associated
with decreased survival
• Deficiency shown to be a risk for TB
100 – 200 µg/day
Vitamin E
Deficiency compromises immunity – damage to
immune effector cells due to free radical
reactions
Significant declines in CD4 cell count and
increased progression to AIDS
Supplementation reverses oxidative damage to
DNA caused by Zidovudine
200 – 400 IU/day
Vitamin C
No relationship was found between
plasma Vitamin C levels and HIV
disease progression
Supplementation reverses oxidative
damage to DNA caused by Zidovudine
Vitamin B12 deficiency
Causes:
- Diarrhea due to Cryptosporidium & Isospora belli
- HIV-associated gastric secretory failure (low
parietal cell secretion of intrinsic factor)
- Zidovudine treatment
• Neurological & psychiatric impairment
• Decline in CD4 lymphocyte count
• 2-fold increased risk of progression to AIDS
Iron
Both iron deficiency and iron overload
have been shown to have a deleterious
effect on the immune system
Selenium
Three-fold increased risk of genital
mucosal shedding of HIV – possibility
of increased sexual transmission of HIV
in selenium deficient women
The Food Pyramid
• The food pyramid gives an outline of what
to eat every day.
• It shows a range of daily servings for each
group.
• The number of servings required change
from individual to individual and is
influenced by age, gender, size and how
active the person is.
• Each food group in the pyramid provides
some, but not all, of the nutrients needed
• Food in one group cannot replace those in
another.
• One food group is not more important than
another.
• For good health food from all the groups is
needed.
What kind of food does the body
need?
Food that builds the body
– Dry beans, lentils, peas,
– eggs, meat, fish, chicken,
– milk, cheese, butter, Khoya
Food that gives energy:
– Bread, porridge, rice, potatoes, oats,
– Sugar, fatty foods
Food that protects you from diseases:
– Fruit and vegetables.
Energy needs
– most women and older adults have low energy needs
– children, teenage girls, active women and most men
have average energy needs
– active adults, teenagers and pregnant and breastfeeding
women have high energy needs.
• People with a low energy need must select the lower
number of servings from each food group.
• People with an average energy need should select the
middle number of servings.
• People with a higher energy need have to select the
higher number from the group.
• A slice of bread is 1 serving and a hamburger
bun is 2 servings.
• A serving white rice is the same as a serving
brown rice, but
– brown rice has more nutrients than white rice.
Micronutrients
Vitamin A:
• cheese, eggs, butter, margarine, fish oil and liver. yellow
and green vegetables and yellow fruit, such as carrots,
pumpkin and oranges
Vitamin B:
• cereal foods, bread, nuts, peas, beans, bananas,
potatoes, eggs, milk products
Vitamin C:
• oranges, lemons, cauliflower, cabbage, tomatoes, lettuce,
guavas, green peppers
Vitamin D:
• eggs, milk, butter, margarine
Exercise
Micronutrients
Their source
The role they play
Good eating habits
• Eat less meat
• Eat less fat
• Do not skip meals or eat only when you are
hungry.
• Listen to your body: do not eat foods that make
certain symptoms worse.
• Cut down on smoking.
• Avoid drinking alcohol.
• Try eating fruit and vegetables raw. If you have to
cook them use a low heat, or steam or bake them.
• Avoid the use of drugs They lower the body’s
ability to fight off disease.
HIV/AIDS reduces food intake
People with HIV/AIDS often do not eat enough
because:
• the illness and the medicines taken for it may
reduce the appetite, modify the taste of food and
prevent the body from absorbing it;
• symptoms such as a sore mouth, nausea and
vomiting make it difficult to eat;
• tiredness, isolation and depression reduce the
appetite and the willingness to make an effort to
prepare food and eat regularly;
• there is not enough money to buy food.
• Buy fresh food every day, instead of weekly or monthly.
• Keep food in the fridge or airtight containers in a dark
place.
• Store raw and cooked food separately in the fridge.
• Keep raw meat away from other food.
• Defrost food in the fridge and not at room temperature.
• Use a separate chopping board for raw meat. A hard
plastic board is better than a wooden board. Disinfect
the board every week using a weak solution of bleach.
• Always cook meat, fish and eggs well. Do not eat raw
eggs.
• Keep leftovers in the fridge.
• Eat only pasteurised dairy products and drink
pasteurised milk.
• Wash fruit and vegetables well before eating.
Exercise
• Calculating Body Mass Index
• Measurement of weight
• Weight record form and its use
Dealing with weight loss
People with HIV/AIDS often lose weight although they eat
healthy food.
Gain weight or keep it steady in the following way:
• If you often vomit or suffer from diarrhea, try to eat yoghurt,
peanut butter, salad dressing, coconut and grated cheese.
• Squeeze lemon juice over fatty foods to help digestion.
• Drink fruit juices, milkshakes and hot chocolate.
• Chew your food well before swallowing.
• Eat four to five small meals instead of three big meals a
day.
• Eat snacks between meals such as raisins, potato crisps,
peanuts, biscuits or dried fruit.
• Patients must know what their right weight should be